How To Effortlessly Count Carbs, Nail Your Insulin And Make Your T1D More Predictable In 5 Easy Steps

Why Counting Carbs Matters

Let’s be real: diabetes is one big, nasty math equation, and the results of this equation matter.

The results is ultimately our blood glucose, more specifically its stability. There are many angles we can look at it, but the three big numbers to consider are:

our average blood glucose
our standard deviation, or how much blood glucose fluctuates around the mean on average
our time in range, the amount of time our blood glucose stays between the ideal range (usually 80-200, but 80-150 is a safer parameter).

Counting carbohydrates is essential to determine the right dose of insulin to give and nail the three numbers above.

Without this number, we can’t calculate the right amount of insulin to inject at any given meal. We become blind to our true Carb To Insulin Ratios and, because we’re at best guessing both the quantity of our meal and the insulin required for it, blood sugar rollercoasters naturally ensue.

Our glycemic index depends in large part on the amount carbohydrates we eat. Simply “Carb Counting” is not going not solve all of our problems: the type of carbs matters just as much, not to mention the speed at which we eat, our insulin timing strategy and our overall level of physical activity, just to name a few (remember, there are at least 42 variables).

However, Carb Counting is one of the biggest bangs for your buck. When you’ve hardcoded this habit mastered the process of adjusting your insulin ratios, you’re on a path that leads to success.

So let’s go through the steps you must know to count your carbs correctly, dose your insulin with more precision than ever and improve your T1 results.

What You Need To Cont Carbs

Let’s set ourselves up for success first. Every new habit we are willing to adopt must be easy, accessible, fun, rewarding.

The idea of Carb Counting sounds tedious enough, so our first focus is on reducing friction as much as possible by making it easy, accessible. Here’s the list of basic tools we need to make this work as smoothly as possible.

A system. No brainer, but without a system we are likely to last a couple of days. A system could be as simple as: plan meals in advance —> log food items and their quantity into an app —> note the amount of carbs (in grams) somewhere (preferably you have a sheet or doc, but napkins work too for back-of-the-envelope math when needed) —> divide this number by your C:I Ratio —> Eat.
A scaler, to weigh your food.
An app on your phone. I’ve mentioned it just above, so here we go. There’s a wide selection of free apps to get incredibly accurate breakdowns of their macronutrient content. Among the best ones I’ve ever found are Cronometer and Lifesum. Their databases include all the products you find on the shelf of your supermarkets, and the nutrition facts always match. You can even “create” meals inside these apps, so you don’t have to do everything from zero everytime and make carb counting a 2 seconds thing.
A calculator. You’ll need this to calculate your insulin dose based on your total carbs and your insulin ratio. The calculator app on your phone or your brain are perfect.
A way to make this fast and precise. In an ideal world, you have some tool that automates most of the calculations for you. This helps immensely with speeding up operations. I have created a big Google Sheet that makes all the calculations for me: it keeps track of my ratios and their evolutions and of my blood glucose levels around every meal. All I have to do is to insert the grams of carbs I am eating (I get that from my food tracking app), and in one second I have a precise estimate of the insulin that I need for that meal.
Patience. Yup, you’ll need some of it at the beginning. Carb Counting is not necessarily fun, but it can be, and with time it will become so much easier because you’ll turn into a human nutrition label. After a decade doing this, I basically know all the nutrition facts of the foods at the supermarket, and can estimate with great precision when nutrition labels are not available (like at parties or potlucks)

Lastly, one of the best tricks you can use to make the whole thing less of a chore is standardizing your meals. This doesn’t mean eating exactly the same stuff everyday (nobody should do that, and everyone should aim at a variety of 50 different foods within a week for optimal gut health)!

But if at breakfast you have more or less the same amount of carbs coming from more or less the same type of foods, then you will only have to do the logging once and reuse more or less the same number for any breakfast after.

For instance, I love fruit bowls at breakfast, and I know they contain more or less 150 grams of carbs. If one day I use peaches in place of apples, or trade some bananas for some mangoes, I just make a note and fix my bolus as needed, but I don’t have to do the math from scratch every morning.

Now, let’s count our carbs.

Step 1: Recognize The Carbs

Carbohydrates are the most impactful macronutrient on your blood sugar, so it is a good idea to know where the carbohydrates are.

A second very good idea is to learn to distinguish which foods contain simple carbohydrates and complex carbohydrates (and most importantly, which ones contain refined carbohydrates). You’ll develop this awareness with time, and it will certainly become easier and easier. But this distinction is just too important to have clear in the mind.

First thing to consider is that not all carbs are equal. 100 grams of apples, 100 grams of buckwheat, 100 grams of orange juice and 100 grams of white bread belong to different universes…and so does their impact on blood glucose.

If one’s intention is to maximize blood glucose stability (and, why not, be a healthier human being in general), a good rule of thumb is to avoid refined carbohydrates as much as possible and rely on whole carbohydrates.

Recognize that pizzas, breads, pastas, bagels, cookies and any other baked or sugary product that surrounds us is, as its core, pure sugar. That is the definition of ultra refined foods. Stuff like white flour and all the foods derived from it should be the exception rather than the rule.

Additionally, this information can save you: if you are on an urgent low, it is good to know that you can find simple carbohydrates in an orange juice and their impact on the glucose concentration in your bloodstream will be much more immediate than eating some buckwheat.

Step 2: DetermineThe Amount Of Carbs In Your Food

Here’s where the nutrition facts labels and the food tracking app become important. You must gain a precise idea of the types of foods that you are about to eat, the type of carbohydrates they contain (complex, simple, whole or refined…please avoid refined as much as you can).

Then you must consult tables with the nutrient value of foods (the web is full, here are some)

At the beginning this can feel like the very last thing you want to do, you just want to eat in peace. But it’s very important to do, so power through the first couple of days knowing that time and experience will make this easier: the more you do this, the less time you spend doing it. And I can tell you by experience that after a few weeks all the info you need will be sedimented deep in your brain.

Step 3: Adjusting The Quantity Of Carbs Using Portion Size

This is when your scaler enters the scene.

Note:

the nutrition labels will in most cases report the amount of carbohydrates per 100 grams of product. It is important to understand that 100 grams of a product does not mean 100 grams of carbohydrates. For instance, 100 grams of brown rice contain around 70 grams of carbohydrates, so this is the number you should refer to when you calculate your insulin in case you eat 100 grams of brown rice. Most food tracking apps use 100 grams as the default quantity, but they all let you adjust that number based on your need.
Check whether the reported carb content refers to the weight of the food raw or cooked. 100 grams of raw rice will contain much more carbs than 100 grams of cooked rice.

You’ve decided you’re going to have a salad bowl with 80 grams of brown rice, 200 grams of chickpeas, 100 grams of tomatoes and 100 grams of lettuce for lunch.

Step 1: determine the quantity of carbs contained in those ingredients;
Step 2: Adjust the quantity from the default 100 grams to the 80 grams you’re going to eat (80%). If 100 grams of rice contain 70 grams of carbs, just multiply 70*0.80 and you know your portion of rice contains 56 grams of carbs;
Step 3: Repeat for all the ingredients in your plate (rice, chickpeas, salads, dressings, etc) and the app will automatically show the total macronutrients split.

OR YOU CAN SPEED UP THIS WHOLE THING…

If you have the Cronometer app (or any other) on your phone, you can scan the bar code of the product, adjust the quantities and the above three steps above will take one minute total.

Here’s the total macronutrients split calculated in Cronometer:

Now you know how many total grams of carbohydrates (and proteins and fats) your meal contains and you are ready to calculate the right insulin dose.

Note: If you don’t have access to a food tracking app, you can just make a note of the amount of carbs written on the nutrition facts on a napkin or on the notes app of your phone. If you are not able to weigh your ingredients, you can always rely on tools like the size of your hand, classes or cups. Just know that, with time you’ll be able to assess the weight of food just by looking at it.

Step 4: Calculate the dose of insulin

You know the precise quantity of total carbs, proteins and fats in the plate in front of you, the last piece of math is figuring out the right amount of rapid insulin.

For this, you need two quantitative variables:

the total amount of carbohydrates (in grams)
your carb to insulin ratio (C:I Ratio)

Then you just divide the total grams of carbs by your ratio and you’ll have the insulin units you need.

In our case, the total carbs are 118g. If our C:I Ratio was 10:1 (meaning that one unit cover ten grams of carbs), the calculation would be 118 : 10 = 12 units of insulin.

*The units you need for this particular meal, based on your current C:I Ratio*

But wait, how do I know my C:I Ratio?

There is one important prerequisite here, though: you must know your carb to insulin ratio to begin with!

Your endo or doctor might have given you a ratio on your last visit, but rest assured that that ratio ceased to be valid a few hours after your endo “prescribed” it to you.

Our ratios evolve day by day, if not hour by hour. There are 42 variables affecting us diabetics, remember?

If my ratio at breakfast was 10:1 but I had a very stressful morning, I’ll probably be more insulin resistant at lunch, so my ratio could be 9:1 or 8:1 (i.e. I need more insulin). Same story if it’s super hot outside, if I am dehydrated, or sleep deprived. By contrast, if I trained or spent my morning moving around I’ll be more insulin sensitive: my ratio could increase to 11:1 or 12:1 (i.e. I need less insulin).

YOU MUST TRACK THESE LIFESTYLE FACTORS AND BE AWARE OF HOW THEY AFFECT YOUR INSULIN SENSITIVITY AT ANY MOMENT.

How? Keep a journal, be it pen and paper or digital. Napkins or the palms of your hands are good too.

Any place that makes it easier for you to quickly assess how much you ate, how much you injected, what happened to your blood glucose after and why will work. You must understand the why behind your blood glucose levels. There’s always a reason and it is up to us to find it.

When you have a system to track these things, adjusting your ratios and knowing how they change will not be a problem, so your boluses will be spot on.

I wrote an article a while back to show you how I track this on paper and how I created a script that does all these calculations for me on my phone. I have since improved that and created a template that can be shared with others. If you’re interested to have it, feel free to let me know with a comment or via email.

Step 5: Corrections And Other Measures To Nullify Blood Sugar Rollercoasters

Great, all the math is done! You know what’s in your meal and the exact amount of insulin you need for it.

But there are a few other important things to know and do to secure your time in range for good. Here they are:

Fats and Proteins: they’re going to delay the glucose kick in your bloodstream, so if you’re going for a higher fats or higher proteins meal you should expect a delayed rise. I like to split my bolus, giving a part of it at meal time and a part of it 2/3 hours later. Circumstances vary and we need to interpret them to nail our insulin timing.
Insulin Timing - Pre Bolusing: you can’t expect insulin to be fully receptive in one second. It’s a good idea to give it some minutes to get up to speed before jumping on your food. The amount of time for a pre bolus varies depending on circumstances. You might need to reduce this time if your blood sugars are low or if you’ve just done aerobic exercises. You might want to increase it if your blood sugar is high, or you have been sitting all day, or had a bad night of sleep.
Insulin Timing - Post Bolusing: this is crucial for meals that are higher in fats and proteins. They increase our insulin resistance and delay the rise in blood glucose. The more fats and proteins in your meal, the longer the delay (this is why when you eat pizzas, which are drenched with oils, you see the spike five or six hours after).
Corrective Factor (Insulin Sensitivity Factor): in the case of a hyperglycemia, you need a corrective insulin dose to fix it. Here’s the formula to get it.

Finally, we need to fix our Carb:Insulin Ratio, because the one we used clearly didn’t work.

With a Carb:Insulin Ratio of 10:1, we calculated and injected 12 units of bolus for 118 grams of carbs.

But our blood glucose after the meal reached 250, and we needed 3 extra units. So we need to fix our ratio to take this into account and be more precise with our next meal. ur predicated made our blood glucose spike up to 250, and we needed to we need to adjust our Carb:Insulin Ratio. Here’s how

*The Carb:Insulin Ratio, adjusted and ready to be used for our next meal!*

There you go! Now you have all the pieces.

If this looks tedious, it will get incredibly easier and faster within a few days, trust me.

I have created a Google Sheet script that calculates EVERYTHING for you, including your doses for each meal, the changes in your Ratios, and the corrective factor.
Let me know in the comments if you are interested to have it.

I hope it helped, and please please please let me know if you have any doubts.